Bacterial Meningitis Vaccines and the Prevention of Meningitis in Cochlear Implant Recipients

Karen Broder, M.D.Epidemic Intelligence Service Officer

National Immunization Program Centers for Disease

Control and PreventionFebruary 24, 2003

US Meningitis Vaccines

• Haemophilus influenzae Type b Conjugate (Hib) (several brands)

• Meningococcal Polysaccharide

(Menomune®) • Pneumococcal Polysaccharide

(Pneumovax®)• Pneumococcal Conjugate (Prevnar®)

US Vaccination PolicyNationalInstitutes ofHealth (NIH)

VaccinePre-licensure

VaccineLicensure

Food and DrugAdministration(FDA)

Centers for DiseaseControl andPrevention (CDC)

Advisory Committeeon ImmunizationPractices (ACIP)

VaccineRecommendations

High-RiskGroups

Persons withMedicalConditions

Persons withSocial/EnvironmentalRisk Factors

Universal Age-Appropriate

Recommended Childhood and Adolescent Immunization Schedule, US 2003

Vaccine Age

Birth1

mo2

mos4

mos

Hepatitis B1

Diphtheria, Tetanus, Pertussis2

Haemophilus influenzae Type b3

Inactivated Polio

Measles, Mumps, Rubella4

Varicella5

Pneumococcal6

Hepatitis A7

Influenza8

HepB #1

HepB #2

4-6 yrs

6 mos

12mos

15mos

18mos

24mos

11-12 yrs

13-18 yrs

HepB #3

DTaP DTaP DTaP DTaP TdDTaP

Hib Hib Hib Hib

IPV IPV IPV IPV

MMR #1 MMR #2

Varicella

PCVPCVPCVPCV

Hepatitis A series

Influenza (yearly)

Vaccines below this line are for selected populations

range of recommended ages catch-up vaccination

HepB series

MMR #2

Varicella

PPVPCV

only if mother HBsAg ( - )

preadolescent assessment

http://www.cdc.gov/nip/recs/child-schedule.htm

Haemophilus influenzae Type b (Hib) Vaccine

• Universal immunization for children aged <5 years

• High-risk indications for persons aged ≥5 years – Immune system disorders

Meningococcal Vaccine

• Not universal immunization• High-risk indications usually for persons

aged ≥2 years– Travel to endemic country– Outbreak control – College Freshman living in dorm (often optional)– Immune system disorders

Pneumococcal Polysaccharide Vaccine (PPV23)

• Universal immunization for adults aged ≥65 years

• High-risk indications for persons aged 2-64 years– Immune system disorders– Residence in special environments or social

settings– Chronic medical conditions

Chronic Medical Conditionswith PPV23 Indication

• Cardiovascular disease• Pulmonary disease (not asthma)• Diabetes mellitus• Alcoholism• Chronic liver disease• Cerebrospinal fluid (CSF) leaksCerebrospinal fluid (CSF) leaks

Pneumococcal Conjugate Vaccine (PCV7)

• Universal immunization for children aged <2 years

• High-risk indications for children aged 2-4 years

• Moderate-risk considerations for children aged 2-4 years

PCV7 High-Risk Indications Children Aged <5 Years

• Immune system disorders

• Chronic medical conditions

– Similar to PPV23, including CSF leaks

PCV7 Vaccine SupplyNational Vaccine Shortage

Public Health ResponseMeningitis Vaccination and Cochlear

Implant Recipients

• Reviewed meningitis vaccination recommendations

• Disseminated vaccination information to stakeholders– Cochlear implant recipients– State health departments– Health care providers

Immunization Response to Cochlear Implants and Meningitis Association

• Could vaccination decrease the risk of meningitis among cochlear implant recipients?

Review of Vaccination Policy

• Vaccine-preventable cause?– Yes, pneumococcus

• Biological plausibility?– Yes, potential anatomic pathways and

other mechanisms

Review of Vaccination Policy

• Applicable ACIP high-risk indication?– Yes, pneumococcal vaccination for

persons with CSF leaks

• Accessibility concerns? – Yes, national PCV7 vaccine shortage

CDC Recommendation for Cochlear Implant Recipients: High-Risk

Pneumococcal Vaccination

Information ResourcesCochlear Implants and Vaccination

• NIP Website – General public http://www.cdc.gov/nip/issues/cochlear/cochlear-gen.htm– Health care provider http://www.cdc.gov/nip/issues/cochlear/ cochlear-hcp.htm

• National Immunization Hotline – English

(800)232-2522– Spanish (800)232-0233 – TTY (800)243-7889

Pneumococcal Vaccination Schedule for Unvaccinated

Cochlear Implant Recipients

Age in Years

PCV7* PPV23**

<2 √

2-4 √ √

≥5 √

* ACIP Age-appropriate high-risk schedules should be followed

** PPV23 and PCV7 should be administered ≥ 2 months apart.

Vaccination for Cochlear Implant Recipients

• Four bacterial meningitis vaccines

covering three causes of meningitis • No initial specific vaccination

recommendations • Current pneumococcal vaccination

recommendations • Following study need to reevaluate

vaccination recommendations

Acknowledgments

• Cochlear Implant Team including: J. Reefhuis, M. Honein, S. Chamany, K. Biernath, C. Whitney, E. Mann, S. Manning, S. Avashia, M. Victor, B. Culpepper, P. Costa, and C. Boyle

• Immunization Team including: J. Moran, B. Schwartz, T. Murphy, K. Bisgard, M. Wharton, L. Pickering, M. Bailey, the State Immunization Coordinators and the National Immunization Hotline